COMPARATIVE STUDY BETWEEN FUNCTIONAL OUTCOME OF LUMBAR LAMINOPLASTY AND DECOMPRESSIVE LAMINECTOMY FOR MULTILEVEL LUMBAR SPINAL CANAL STENOSIS

Professor Dr. Md. Anowarul Islam*, Dr. Md. Shohidullah, Dr. Sarwar Rahman, Dr. Mohsina Khan, Dr. Sariful Hasan

ABSTRACT

Background: Abnormal narrowing of the lumbar spinal central canal, lateral recess, foramen and extraforaminal space is called lumbar spinal canal stenosis. Patients present with low back pain with or without radiculopathy and neurological claudication and may need surgical intervention, if conservative treatment fails. Lumbar laminoplasty and decompressive laminectomy are few of the surgical intervention techniques. Objectives: To evaluate and compare the functional outcome of lumbar laminoplasty and decompressive laminectomy for patients with multilevel lumbar spinal canal stenosis. Methods: 60 consecutive patients underwent lumbar laminoplasty and decompressive laminectomy in BSMMU from September 2017 to March 2020. The patients were randomized into two groups: one group for lumbar laminoplasty and another group for decompressive laminectomy. Two patients from each group were dropped out at final follow up. Remaining patients were followed up for 12 months. Outcome were measured by VAS, JOA, ODI score and Modified Macnab’s criteria. All the data were compiled and sorted properly and the quantitative data was analyzed statistically by using Statistical Package for Social Science (SPSS-22). The results were expressed as percentage and mean ± SD and p<0.05 was considered as the level of significance. Results: Post-operative mean hospital stay was 5.57 ± 0.63 and 5.44 ± 0.70 days in group A and B respectively. Pre-operative mean VAS score of back pain and leg pain were 6.86±0.65 and 6.93±0.81 which were reduced to 1.04±0.19 and 1.11±0.31 in laminoplasty group where as in laminectomy group, preoperative VAS for back pain and leg pain 6.96±0.65 and 6.89±0.80, which reduced to 1.37±0.56 and 1.44±0.58 respectively at 12 months postoperatively. JOA score significantly increased from 10.68±1.06 preoperatively to 27.57±0.63 postoperatively in laminoplasty group and from 10.78±1.01 preoperatively to 25.59±1.12 after 12 months of surgery in laminectomy group. ODI score reduced from 34.43±2.99 to 8.39±1.59 in laminoplasty group and from 34.93±2.22 to 8.81±1.42 in laminectomy group. Final outcome according to modified Macnab’s criteria, Excellent in 17(60.7%), good in 9(32.1%) and fair in 2(7.2%) patients in laminoplasty group whereas 16(57.1%) were excellent, 9(32.1%) were good and 3(10.7%) were fair in laminectomy group. P value was 0.004. Conclusion: Lumbar laminoplasty and decompressive laminectomy are almost same as effective treatment of patients with multilevel lumbar spinal canal stenosis.

Keywords: Lumbar spinal canal stenosis, neurogenic claudication, lumbar laminoplasty, decompressive laminectomy.